VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1403753
Sex: M
Age: 41
State: FL

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient had received a vaccine that had been in the refrigerator longer than 6 hours. Vaccine was punctured at 3:35pm on 6/15/21. It was given to the patient on 6/16/21 at 3:15PM. Patient does not have any adverse events at this time.

Other Meds: esomeprazole

Current Illness: n/a

ID: 1403754
Sex: M
Age: 13
State: MD

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: During the night that he got the vaccine my son woke up with hives and I gave him some Benadryl. I gave him his rescue inhaler in the afternoon. He has not used his inhaler for over a year. The next day he had hives were much worse and his fever was going up. The hives were worse on his left arm and his arm was red around the vaccination site. He also had swelling in his face and he was having a little trouble breathing. I gave him Benadryl and Zyrtec which helped as well as Pepcid. The breathing difficulty subsided after that. He got a different rash on his back that was different from the original hives. We continued the medications and he was still Febrile until the sixth day. The sore throat is still present after nine days but the fever and hives are gone.

Other Meds: Albuterol PRN

Current Illness:

ID: 1403755
Sex: M
Age: 49
State: GA

Vax Date: 06/03/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%.

Other Meds:

Current Illness:

ID: 1403756
Sex: F
Age: 32
State: UT

Vax Date: 12/28/2020
Onset Date: 01/10/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: some makeup products , I can't put on my face

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Two to 3 weeks after the vaccine, I had restless leg syndrome, it felt like my legs were going to cramp at night unless I move them, it would happen consistently for about a week , it would stop and then come back . It still is going on I just found home remedies to fix it for now and my doctor has recommended, like warm or cold compressions, like a heating pad.

Other Meds: ethylphenidate 27 mg 1x day multi vitamin

Current Illness: Had covid-19 symptoms in November 24th, but tested negative

ID: 1403757
Sex: F
Age: 32
State: PA

Vax Date: 03/05/2021
Onset Date: 04/02/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penacillian Sulfur Ceoraset Adhesive Tape

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Chest pain

Other Meds: Synthroid10mg/1xdaily Panthrozal40mg/1xdaily Eziko10mg/2xdaily Folic Acid100mg/1xdaily Zertec 10mg/1xdaily Iron 65mg/2xdaily Vitaminc C 500mg in the morning/1000mg afternoon Tromantadine 40mg/1xdaily Levenodestro 1xdaily

Current Illness: None

ID: 1403758
Sex: F
Age: 27
State: TN

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: immediately after patient had injection administered she fainted. The pharmacist that administered the Moderna was still seated right beside her still and patient was seated. The pharmacist gently lowered patient to floor and called for help. I called a code white and went to patient. Pt was disoriented and hot. Gave her an icepack and had management get her a water. After several minutes she was no longer disoriented and was embarrassed. She said "she is a baby" and just freaked out a little. She said she was on lunch break to get the shot and had not eaten lunch. I offered to get her something to eat but she refused. I contacted someone to come pick her up since I didnt want her to drive after being disoriented. I also called her boss to let her know she would not be coming back to work per her request. I followed up with her and she said she was feeling perfectly fine and completely over the inicident.

Other Meds: unknown

Current Illness: none

ID: 1403759
Sex: M
Age: 40
State: AZ

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKMA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was given Moderna instead of Pfizer for his second dose in the series. There were no side effects or difficulties. Patient requested "Moderna" and if was given - then when we went to document on his card, it showed that Pfizer had been given for his first dose. We notified our vaccination team at our organization, the medical director and annotated in the patients chart. No adverse effects noted.

Other Meds: HCTZ, Losartan, Clotrimazole

Current Illness: none

ID: 1403760
Sex: M
Age: 24
State: CA

Vax Date: 06/11/2021
Onset Date: 06/13/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient started feeling congested on Sunday and then reported no small or taste the next day with fever 102F.

Other Meds:

Current Illness:

ID: 1403761
Sex: F
Age: 19
State: CA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore arm started 6 hours after injection Headache, fatigue, low grade fever started in the middle of the night lasted 3 days

Other Meds: None

Current Illness: None

ID: 1403762
Sex: F
Age: 25
State: OR

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bee Venom Protein, Grass, Milk, Pear

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient is a 25 yo woman who just had her second Pfizer vaccination approximately twenty-five minutes earlier. She reports "tightness" in her throat, but no evidence of stridor or difficulty breathing. She remarked that she had similar symptoms after her first dose and was treated with diphenhydramine 25 mg orally with relief. She requests and was given, diphenhydramine 25 mg and a bottle of water. After approximately thirty minutes, she reported the resolution of her symptoms and requested to leave the extended monitoring section. 6/14 ED visit for nausea and SOB - zofran given

Other Meds:

Current Illness:

ID: 1403763
Sex: F
Age: 67
State: IA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Food sensitivities - give diarrhea and itching - eggs, cane sugar; yeast; bananas; amaranth grain; beans; soy; corn; gluten; sunflower; avocado and asparagus medicine sensitivities - codeine - makes me nauseous - no anaphylactic reaction; Sunblock and deodorant - allergic to.

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: The next morning - I had a fever, body aches, flu-like, headache - 09:00 am - 07:00 or 8 at night. Within a couple of days, (COVID gave me a horrible cough which I'm still not over) my cough came back with a vengeance. I couldn't stop coughing. I had more body aches and felt like I couldn't recover if I tried to do a little workout - it would stay sore. I continued to have muscle soreness, aches and pains and also I brain fog. (I had COVID symptoms prior to the vaccines with COVID stuff.) It seemed like it brought all the COVID inflammation back. Brain fog is now 90% gone but I do still hit a wall every day at about 05:00 pm or so in the evening; when it was at it's worse, I couldn't think in a straight line. Decisions were really hard and I ended up being depression from that - felt alone, tired and whiny. I asked for help from a bunch of people including a naturopath - gave me adrenal support and mitochondrial support and so my symptoms are improving. I still have coughing but I'm slowly getting better. I still get tired and brain fog is better but it's not gone yet.

Other Meds: Acyclovir - anti-vital; Levothyroxine; supplements - b-complex; Lutein ; D3; Olive leaf supplement; One supplement: glucosamine/MSM/chondroitin; Fish oil; Probiotic; Mix of calcium; magnesium and zinc; Multivitamin; baby aspirin; Potassium

Current Illness: COVID - November (middle of the month) 2020

ID: 1403764
Sex: F
Age: 14
State: GA

Vax Date: 06/04/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%. Customer is understands error and is not interested in revaccination. VAERS (copy in SOP folder).

Other Meds:

Current Illness:

Date Died: 05/12/2021

ID: 1403766
Sex: M
Age: 37
State: VA

Vax Date: 05/10/2021
Onset Date: 05/12/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Individual passed away within 48 hours of receiving vaccine.

Other Meds: ibuprofen

Current Illness: Unknown

ID: 1403767
Sex: F
Age: 62
State: SC

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Within 3 minutes after the shot , I got dizzy, felt warm, sick to my stomach, and it felt like someone was squeezing down my spine in 4 places in succession and I let out some gas. This reaction lasted maybe 2 minutes and it disappeared. It was like a wave of reactions that happened quickly, 1 after the other.

Other Meds: None

Current Illness: None

ID: 1403768
Sex: F
Age: 62
State: CA

Vax Date: 06/13/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient came to get the vaccine on 6/13/21 and she was sitting down for 15 minutes but after a few minutes she waved me over and said she was feeling really weak for no appearent reason. I asked her to take a few deep breaths and she did and calm her down. She had a water bottle with her and I asked her to drink some water and she did. After a few minutes she felt a little better. I checked her blood pressure and it was 174/105 and I asked her to sit for a few minutes, deep breaths, and for her to relax as much as she can. I took her blood pressure a few more times. After about 15 mintes she felt a lot better and her blood pressure was 140/88. I asked if she needs me to call someone or if she needs to go to the hospital. She said she was a lot better andwent back to work. I saw the patient a few days later and the patient said she had to go to the hospital but she is ok now. Apologize to the patient that she had to go to the hospital. the patient was fine and said she was glad to get her second dose of moderna. scrt and vaers entered

Other Meds:

Current Illness:

ID: 1403769
Sex: F
Age: 50
State: TN

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient stated that her arm was sore as of 6/16/21. This soreness has lasted longer than 2 months now with no resolution.

Other Meds: unknown

Current Illness: Unknown

ID: 1403770
Sex: F
Age: 64
State: HI

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: peanuts, dust mites, pet dander, pollens,

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Fairly strong all over muscle pain, especially at injection site, some nausea and stomach pain, some shivering, inability to sleep for 5-6 hours. Some muscle pain at current time, 20 hours after injection.

Other Meds: Allegra, Azelastine, zinc-l-carnosine, CoQ10,biotin turmeric, probiotic, omega-3 fish oil, aloe vera gel, various vitamins and minerals

Current Illness: none

ID: 1403771
Sex: F
Age: 15
State: GA

Vax Date: 06/04/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%. Customer is understands error and is not interested in revaccination. VAERS (copy in SOP folder).

Other Meds:

Current Illness:

ID: 1403772
Sex: M
Age: 69
State: NJ

Vax Date: 02/10/2021
Onset Date: 02/20/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After the first vaccination on 2/10/2021 he started feeling weird in a nonspecific way. About 10-40 minutes later he started having episodes that have been diagnosed as seizures. He also developed erectile dysfunction in the same timeframe. Seizures are classified as facio-brachial-dystonic seizures and temporal lobe seizures. Clinically seizures began with a warmth feeling going up the left side of his neck, then has a quick vocalization and a sudden body jerk more on the left side. There is no postictal state. They can occur up to 10 times a day or more. They occur in sleep as well. Documented on video EEG testing. Has been refractory to medication, is currently on Keppra and Vimpat without full seizure control. Also had hyponatremia. Having memory decline. See test results below.

Other Meds: amlodipine, clonazepam, hydrochlorothiazide-irbesartan, levothyroxine, metformin, simvastatin. Was also on supplement "Redwood nitrous oxide booster."

Current Illness: None.

ID: 1403773
Sex: M
Age: 17
State:

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: Shellfish

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Fatigue, headache, low grade fever starting that night lasting about 36 hours

Other Meds: None

Current Illness: None

ID: 1403774
Sex: F
Age: 32
State: MD

Vax Date: 06/08/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish, Surgical Adhesive

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: warmth to touch left arm injection site 8 days later, arm soreness, headaches

Other Meds: Trazedone, Colonazepam, Tizanidine

Current Illness: none

ID: 1403775
Sex: F
Age: 56
State: AZ

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: First dose administered 3/24/21, and second dose administered 84 days later (42 days beyond CDC recommendation).

Other Meds:

Current Illness:

ID: 1403776
Sex: M
Age: 57
State: PA

Vax Date: 04/27/2021
Onset Date: 04/30/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Metronidizol

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Three days after the vaccine I started to have tightness in my chest when exercising. On June 9, I had a mild heart attack. One June 10th, heart catheterization revealed that I had blockage in two arteries

Other Meds: Fish oil Niacin 500mg Levothyroxin 100mg Prestiq 10

Current Illness: None

ID: 1403777
Sex: M
Age: 44
State: GA

Vax Date: 06/04/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%. Customer is understands error and is not interested in revaccination. VAERS (copy in SOP folder).

Other Meds:

Current Illness:

ID: 1403778
Sex: F
Age: 18
State: NY

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: 6/16/21 patient had an episode of syncope within 5 minutes of vaccine administration - fell and hit tailbone first, then hit head against the ground and had brief seizure witnessed by mother (full body shaking), LOC, unresponsive, pale and cold/clammy. lasted for several seconds. no PMH of syncope, seizures. no medical problems

Other Meds: NONE

Current Illness: NONE

ID: 1403779
Sex: M
Age: 40
State: OH

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: First shot one month prior, no issues at all. Soreness at the injection site. Second shot: Next day, high fever, chills, severe muscle and joint pain. Two days after, violent vomiting. increased joint pain, fever, trouble thinking clearly. Three days after, numbness in my left hand, and loss of sensation in my entire right foot. As of 6-16, loss of feeling still continues. 1 week after, chest and lung pain, I think my heart is hurting, almost like random stabbing pains through it, random waves of muscle and joint pain. Issues sleeping. Issues with thinking clearly. I have felt run down since receiving my second shot. Loss of appetite and foggy brain.

Other Meds: None

Current Illness: None

ID: 1403780
Sex: F
Age: 85
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: BACTRIM [CO-TRIMOXAZOLE], PENICILLINS CLASS, SULFA (SULFONAMIDE ANTIBIOTICS)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt received Pfizer vaccine on 6/16/2021 but patient had already received both doses of Moderna on 2/2/2021 and 3/3/2021. Pt stated she did not remember receiving both doses of Moderna in the past. Pt advised and explained it won't be necessary to received second dose of Pfizer due to being fully vaccinated with Moderna. PCP notified, pt will not receive any additional doses. Pt monitored for 20 minutes with no adverse effects noted.

Other Meds: Losartan (COZAAR) 100 mg Oral Tab, Levothyroxine (LEVOTHROID/SYNTHROID) 100 mcg Oral Tab, Ergocalciferol, Vit D2, (DRISDOL) 1,250 mcg (50,000 unit) Oral Cap, Alendronate (FOSAMAX) 70 mg Oral Tab, Simvastatin (ZOCOR) 40 mg Oral Tab

Current Illness: n/a

ID: 1403781
Sex: F
Age: 51
State:

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Sore arm that evening Fatigue and headache started approx 24 hours injection lasted for 2-3 days , headache intermittent w/ fatigue

Other Meds: None

Current Illness:

ID: 1403782
Sex: F
Age: 35
State: WI

Vax Date: 04/14/2021
Onset Date: 04/20/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Gluten Dairy Benadryl

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: About 6 days following my first dose, I started to experience periods of heart racing and difficultly breathing. This lasted for several days but then went away. Again, about 6 days following my second dose, I started to experience racing heart and difficulty breathing. This has continued to occur to date. My doctor had me wear a heart monitor for 48 hrs. My resting heart rate was 91 bpm with my highest at 164 bpm ( i believe). There were no events that would trigger the tachycardia.

Other Meds: Thyroid NP 1.5 GR Adderall XR 30 mg Naproxen 500 mg 2x daily Amitriptyline HCL 10 mg Magnesium 800 mg

Current Illness:

ID: 1403783
Sex: F
Age: 31
State: CA

Vax Date: 06/02/2021
Onset Date: 06/07/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: MAJOR BRAIN FOG, ANXIETY, HEART BEAT HAS BEEN RACING, WEIRD DREAMS, AND NOT BEING ABLE TO SLEEP MOST NIGHTS NOW.

Other Meds: none

Current Illness: none

ID: 1403784
Sex: M
Age: 51
State: TX

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: patient broke out in measles type bumps that then turned into what sounded like hives on bicep and tricep in particular

Other Meds:

Current Illness:

ID: 1403785
Sex: F
Age: 14
State: UT

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Client was needed a second dose of pfizer, but was accidentally given moderna and she is 14 .

Other Meds: unknown

Current Illness: no

ID: 1403786
Sex: M
Age: 22
State:

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: AT TIME OF INJECTION, PATIENT FELT LIGHT HEADED, DIZZY, TUNNEL VISION, NAUSE (HAD SOME VOMITING), CLEARED UP WITHIN 5 MINUTES, FELT BETTER WHEN DRANK GATORADE

Other Meds:

Current Illness:

ID: 1403787
Sex: M
Age: 41
State: CA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No know drug allergies

Symptom List: Tremor

Symptoms: Patient had reported fever, chills, sweats, severe right upper arm injection site pain, difficulty breathing, and chest pressure 4 hours after the vaccine administration. Patient had gone to the emergency room on June 15, 2021.

Other Meds: Biktarvy

Current Illness: none

ID: 1403788
Sex: F
Age: 68
State: PA

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Albuterol, symbicort, Zico?s, Lipitor, Crestor, Trazadone, Percocet , Amox-clav , omeprazole, lexapro, methylprednisone , and any mediCations contraindicated with long qt syndrome

Symptom List: Erythema, Pruritus

Symptoms: Muscle weakness for 2 months following vaccine Lymph node pain 5 weeks Triggered arthritis and costochondritis for 6-7 weeks Headaches for 2 weeks

Other Meds: Dofetilide, carvedilol, eliquis, pravastatin ? BREO, lasix, potassium chloride, magnesium oxide, synthroid and calcium and vitamin D

Current Illness:

ID: 1403789
Sex: M
Age: 42
State: IL

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: none

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: After about 5 minutes patient became light headed and became prone on the floor. Patient became nauseated and vomited.

Other Meds: none

Current Illness: none

ID: 1403790
Sex: M
Age: 23
State: CA

Vax Date: 06/11/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: morphine

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: myocarditis - admitted to the hospital 6/14 with chest pain.

Other Meds: None

Current Illness: None

ID: 1403791
Sex: M
Age: 11
State: NC

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt was given Covid vaccine 16 days before turning 12 years old. Facilitator was back documenting due to WiFi problems and realized this patient was not 12 years old. She informed me and I went to the vaccinator that vaccinated this patient to ensure she knew the vaccine requirements. All staff was told before the clinic started the mandatory age requirements and told all DOBs were written in red on a sheet of paper on every table.

Other Meds:

Current Illness:

ID: 1403792
Sex: M
Age: 68
State: MI

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None known

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Woke up the morning after the first shot with a sagging face on the left, watery eyes, runny nose. Was taken to the hospital May 30 to get checked and was diagnosed with Bell's Palsy, given antibiotics, steroids, and and eye ointment. As of June 16th he still has not recovered.

Other Meds: Baby Aspirin.

Current Illness: None

ID: 1403793
Sex: F
Age: 37
State: WA

Vax Date: 12/26/2020
Onset Date: 06/01/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: hydrocodone; Toradol

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: I had schedule an appt with my primary care doctor on January 18th for symptoms: January 1st - swelling - huge sore lump that bulged out under my armpit (injection site arm)- became more sore over time. Any times I did any activities it became more irritant. 2nd vaccine - (I had my ultrasound - first one - the day before the 2nd vaccine) - January 23 - 28 days after - on right arm and nothing happened after that vaccine - except that I had flu-like symptoms, fever, body aches - and was out of work for a week but nothing happened on my right side lymph nodes. It's still there with the large lymph nodes on the left side under the arm - very large and irritable (just as irritable as it every was) - they aren't finding anything that will help. Still ongoing.

Other Meds: no

Current Illness: no

ID: 1403794
Sex: U
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Pt woke up from chest pain on 6/10/21 in the morning. He told me it was an 8 out of 10. He felt like it was by his heart in center of chest at nipple level. Said continuous and sharp. Asked him if trouble breathing, heart racing or feeling nervous, or stomach pain. No to all. He has never had acid reflux, panic or anxiety problems, or asthma. Gave him 10mg famotidine and 400mg ibuprofen. He said pain got worse so we went to urgent care. They did ekg and chest xray and both wnl. He didn't take ibuprofen before bed and woke up with chest pain again Friday, June 11. He has been taking 600mg ibuprofen at bedtime from June 12 to June 15.

Other Meds:

Current Illness:

ID: 1403795
Sex: F
Age: 40
State: CA

Vax Date: 04/24/2021
Onset Date: 05/26/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: ativan -rash vicodin, oxycodone - nausea

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: 40 year old lady with hx fibromyalgia, inflammatory polyarthritis, Sjogren syndrome, anxiety who was admitted on 5/26 when she collapsed and noted to have generalized convulsions, bit her tongue and brought to the hospital, found to have another generalized seizure. EEG showed numerous electrical seizures mainly from the right but from 5/28 , had left sided involvement too. She initially was started on Levetiracetam and then Lacosamide, Phenytoin and Valproic acid were addend. She had LP and CSF was unremarkable. CSF was send for autoimmune encephalitis /epilesy panel were negative. On 5/30 she started on Solumedrol 1 gr daily for 5 days for presumably autoimmune seizure. Seizures were improved. Last subclinical seizure was recorded on 6/3/21 around 5 am. Patient had brain MRI shoed slight increased signal in right mesiotemporl , hippocampus region. Of note she had Moderana Covid-19 vaccine around 3 weeks prior to presentation

Other Meds: ? DULoxetine (CYMBALTA) 30 mg Oral CPDR SR Cap Take 1 capsule by mouth daily

Current Illness: none

ID: 1403796
Sex: F
Age: 40
State: CA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Symptoms - Right eye swelling on June 10, rash on right side of face on June 11, swollen lymph nodes on June 12, face tingling on June 15. Initial Diagnosis - Stye on June 13 Later Diagnosis - Shingles on June 16 Initial Treatment - Prednisone and Clindamycin Later Treatment - Valacyclovir

Other Meds: Teami Greens Superfood Blend

Current Illness: None

ID: 1403797
Sex: M
Age: 27
State: WI

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None kn own.

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Swelling of the armpit on the side of injection, upper back pain, shoulder pain.

Other Meds: None.

Current Illness: None.

ID: 1403798
Sex: M
Age: 51
State: NY

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: apples, pollen, pears

Symptom List: Vomiting

Symptoms: patient complained of dizziness, patient became lethargic, diaphoretic, patient complained of nausea vomit, chest pain, shortness of breath. PATIENT TAKEN TO HOSPITAL .

Other Meds: n/a

Current Illness: n/a

ID: 1403799
Sex: F
Age: 12
State: KS

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt was given 0.03mL dose instead of 0.3mL. The mistake was noted while patient was waiting in the office for fifteen minutes to monitor for side effects and a dose of 0.27mL was then administered. No side effects or adverse effects.

Other Meds:

Current Illness:

ID: 1403800
Sex: M
Age: 18
State: MN

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none known

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Person was lain down immediately following vaccination upon fainting. Head was protected during fall by vaccinator. Laid to floor, feet elevated. Pale in appearance. Woke quickly, was oriented. Water was provided, within a couple of minutes was able to sit up and complete recovery in seated position.

Other Meds: None known

Current Illness: none known

ID: 1403801
Sex: M
Age: 70
State: CA

Vax Date: 05/19/2021
Onset Date: 05/24/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Injection site swelling, Limb discomfort

Symptoms: LISTLESS; NO MOTIVATION; TIRED/SLUGGISH/FATIGUE; LIGHT HEADED/WOOZY; OFF-BALANCE/UNSTEADY; FEELING LOUSY; DEPESSED; OVERWHELMING ANXIETY/DREAD; LETHARGIC; EXHAUSTED. STILL EXPERIENCING EFFECTS THOUGH TO LESSER DEGREE. UNABLE TO FOCUS/CONCENTRATE ON WORK ASSIGNMENTS...FEELING OF BEING IN A 'FOG'. WONDER ABOUT THE HOUSE AIMLESSLY.

Other Meds: Gabapentin 600mg; Tamsulosin 0.40mg; 81mg aspirin; Diphenhydam 25mg

Current Illness: NONE

ID: 1403802
Sex: M
Age: 61
State:

Vax Date: 05/03/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Fall due to weakness, severe myalgias, abdominal pain, elevated troponin, burning and pain in the lower legs and feet.

Other Meds: metformin xr, spironolactone, insulin, atorvastatin, lisinopril, aspirin, coreg

Current Illness:

ID: 1403803
Sex: F
Age: 60
State: AZ

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Bactrim, Cipro

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Notes in record state Shingrix given 5/4/21 left arm SQ. This is an employee so I was able to talk with her face to face on 6/14/21. Patient showed me the injection site which was on the lateral aspect of the left upper arm between the bicep and the tricep, well below the deltoid: typically where subcutaneous injections are given. Patient complained of pain, redness and swelling that lasted a couple of weeks. She drew a circle on her arm with her finger illustrating the area of redness, which was approximately 5 inches in diameter. She is concerned about what she calls a ?shadow? circle about 1.5 inches in diameter that is still lingering and wonders if it will ever go away. I noticed a faint circular discoloration when she pointed it out and suggested she discuss with her provider. She also reported feeling sick all over from the shot. I told patient that it looks like the shot might have been given subcutaneous. I asked if this was her first shot for shingles, and she said it was the first, and she is really reluctant to get the second after this reaction. She asked if it might be less severe this time, and I told her I could not say for sure, but it would be a good idea to discuss this with her doctor and get all her questions answered so she could make an informed decision about the 2nd shot. She agreed that would be a good idea.

Other Meds: lisinopril, naproxen, diclofenac, phentermine, trazodone, calcium/vit D, albuterol, loratadine, vit D, flonase

Current Illness: painful legs and moving toes

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm